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34 Cards in this Set

  • Front
  • Back
what is the m/c cause of dementia?
Alzheimer's disease (senile dementia of Alzheimer type)
what are the si/sx of alzheimer's dz?
1. dementia
2. anxiety
3. hallucination/delusion
4. tremor
what may be found in Down's sx pts at younger ages (30-40)?
Alzheimer's dz
how do you dx Alzheimer's dz?
1. clinical
2. definitive diagnosis only possible at autopsy
what is the tx for Alzheimer's dz?
1. anticholinesterase inhibitor can slow dementia
2. antidepressants for psychosis
3. antipsychotics for psychosis
what is the px for Alzheimer's dz?
inevitable decline in function usually over approx. 10 yr
dementia and delirium can both be defined as:
both cause:
1. global decline in cognition
2. memory, personality, motor, and sensory deficits
what are the characteristics of dementia?
1. constant, progressive course
2. usually not reversible
3. constant problem, no daily pattern
4. consciousness is normal
5. no hallucinations
6. tremors not present
what are the characteristics of delirium?
1. sudden onset, saxing and saning daily
2. almost always reversible
3. usually worse at night (sun-downing)
4. consciousness is altered (obtunded state)
5. often classically visual hallucinations
6. tremors ofen present (asterixis, e.g.)
what are the causes of demnetia?
1. alzheimer's
2. multi-infarct
3. Pick's dz
4. alcohol
5. brain infxn/tumor
6. malnutrition (thiamine/B12 def)
what are the causes of delirium?
1. systemic infxn/neoplasm
2. drugs (esp. narcotics and benzodiazepines)
3. stroke, heart dz
4. alcoholism
5. uremia
6. electrolyte imbalance
7. hyper/hypoglycemia
what is the tx for delirium?
1. tx underlying cause
2. control sx c/ haloperidol instead of sedatives--pts are often given benzodiazepines or sedatives for agitation, but these drugs often exacerbate the deliriumb/c they disorient pts even more
what should you NOT give to tx pts with delirium?
No sedatives--pts are often given benzodiazepines or sedatives for agitation, but these drugs often exacerbate the delirium b/c they disorient pts even more!!
what are si/sx of multi-infarct dementia?
1. acutre stepwise decrease in neurologic fxn
2. multiple focal defictis on exam
3. hypertension
4. old infarcts by CT or MRI
how do you dx and tx multi-infarct dementia?
1. dx by clinical and radiographic exam
2. tx=prevent future infarcts by decreasing cardiovascular risks
how do you characterize Pick's dz?
1. clinically resembles Alzheimer's
2. more common in women
3. onset at younger age (50s)
4. frontotemporal dementia
how do you dx Pick's dz?
1. MRI--shows symmetric frontal or temporal atrophy
2. confirm by autopsy
3. Tx/Px as per Alzheimer's
what are si/sx of Parkinson's dz?
1. syndrome of tremor
2. cog-wheel rigidity
3. bradykinesia
4. classic shuffling gait
5. masklike facies
6. dementia from loss of dopaminergic neurons in substantia nigra
what is the pathophys of Parkinson's dz?
*loss of dopaminergic neurons in the substantia nigra
*typically progresses over yrs despite tx
what are ddx of Parkinson's dz?
1. severe depression (bradykinesia and flat affect)
2. intoxication (e.g. manganese, synthetic heroin)
3. phenothiazine side effects
4. rare neurodegenerative dz
what are tx for Parkinsons's dz?
1. sinemet (levodopa=carbidopa)--best for bradykinesia
2. anticholinergics (benztropine/trihexyphenidyl) for tremor
3. amantadine--increases dopamine release, effective for mild dz
4. surgical pallidotomy for refractory cases
which Parkinson's med is best for bradykinesia?
sinement (levodopa=carbidopa)
what are the si/sx of Huntingont's chorea?
1. progressive choreiform movements of all limbs
2. ataxic gait
3. grimacing
4. dementia
5. pts in usually in 30s-50s
what is the pathophys of Huntingon's chorea?
1. autosomal CAG triplet repeat expansion in HD gene
2. atrophy of striatum (esp. caudate nucleus)
3. neuronal loss and gliosis
what is the dx, tx, and px of Huntington's chorea?
dx=MRI--will see atrophy of caudate nucleus (striatum) and pos. fam hx
px=death inevitable
what are the si/sx of ALS (amyotrophic lateral sclerosis)--motor neuron dz?
1. Upper and lower motor neuron dz
2. m. weakness c/ fasciculations (anterior motor neurons)
3. progressing to denervation atrophy
4. hyperreflexia
5. spasticity
6. difficulty speaking/swallowing
what is the dx, tx, and px of ALS?
dx=clinical hx, physical findings
tx/px= supportive, death inevitable, ususally from respiratory failure
what is the dx of cerebral palsy?
1. group of conditions that affect control of movement and posture
2. in approx 70% of cases, CP results from events occurring before birth that can disrupt nml development of the brain
what are si/sx of CP?
1. range from mild to severe
2. condition does not worsen as the child gets older
what is spastic cerebral palsy?
1. m/c form of CP
2. pt's muscles are sitiff, making movement difficult
what is athetoid or dyskinetic cerebral palsy?
1. approx. 10-20% of CP
2. can affect the entire body
3. characterized by fluctuations in m. tone
4. a/c uncontrolled movements
what is ataxic cerebral palsy?
1. approx. 5-10% of CP
2. ataxic form affects balance and coordination
what tx may help to decrease spasticity in cerebral palsy?
1. botox injected into spastic muscles
2. Baclofen (centrally acting m. relaxant)
what form of tx may permanetly reduce spasticity?
1. selective dorsal rhizotomy may permanently reduce spasticity by cutting some of the nerve fibers that are contributing most to spasticity